Medicare Preventive Services

Medicare pays for many preventive services that can help seniors stay healthy. Many diseases and conditions that are common in the elder population can be prevented by being familiar with Medicare's preventive benefits and discussing them with your doctor.

One-time "Welcome to Medicare" Physical Exam for New Enrollees

If your Medicare Part B coverage began on or after January 1, 2005, Medicare will cover a one-time preventive physical exam within the first six months that you have Medicare Part B. The exam will include a thorough review of your health including an electrocardiogram (EKG), education and counseling about the preventive services you need, and referrals for other medical care if you need it. The "Welcome to Medicare" physical exam is a great way to get up-to-date on important health screenings and shots, and to talk with your doctor about your family history and how to stay healthy.

What to Expect During the Welcome to Medicare Exam:

Review of medical history
Blood pressure check
Review of immunization records
Possible vision test*
Possible Electrocardiogram (EKG)*

*Certain medical problems or complaints required in order for doctor to perform these tests

Medicare Preventive Benefits

The Medicare benefits listed below can be a key to long lasting good health if you use them as advised by your doctor.

Bone Mass Measurement - Medicare covers bone mass measurements if you meet certain conditions:

1. This test must be ordered by a doctor or qualified practitioner who is treating you.

2. Every two years or more frequently if medically necessary.

3. You must meet one or more of the conditions below:

Women who are being treated for low estrogen levels and are at clinical risk for osteoporosis, based on their medical history and other findings.
Men and women whose x-rays show previous fractures.
Men and women on prednisone or steroid-type drugs or who are planning to begin such treatment.
Men and women diagnosed with primary hyperparathyroidism.
Men and women being treated with a drug for osteoporosis, to see if the therapy is working.

You pay 20% of the Medicare-approved amounts. (1)*(2)** Covered by Medicare Part B.

Glaucoma Screening - Medicare covers glaucoma screening once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, or African-Americans who are age 50 and older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state. You pay 20% of the Medicare-approved amounts. (1)*(2)** Covered by Medicare Part B.

Cardiovascular Screening - Medicare covers cardiovascular screening that checks your cholesterol and other blood fat (lipid) levels once every five years. An elevated cholesterol level increases your risk of heart disease and stroke. These screenings will tell if you have high cholesterol. You might be able to make lifestyle changes (like changing your diet and activity level) to lower your cholesterol and stay healthful. Your physician may also prescribe cholesterol-lowering medication to help you manage your cholesterol level.

Diabetes Screening - Free diabetes screening is now available once every 6-12 months to those at risk for diabetes, which includes people who have high blood pressure, high cholesterol levels, obesity, or a history of high blood sugar. Other risk factors also may qualify you for a free diabetes screening. Talk with your doctor to see if this screening is right for you.

Colorectal Cancer Screening - Medicare covers several colorectal cancer screening tests. Talk with your doctor about the screening options that are right for you. All people with Medicare age 50 and older are covered. However, there is no minimum age for having a colonoscopy.

Colonoscopy: Medicare covers this test once every 24 months if you are at high risk for colon cancer. If you are not at high risk for colon cancer, once every 10 years, but not within 48 months of a screening sigmoidoscopy. You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient department. (1)*(2)** Covered by Medicare Part B.

Fecal Occult Blood Test: Medicare covers this test once every 12 months. You pay nothing for a fecal occult blood test. Covered by Medicare Part B.

Flexible Sigmoidoscopy: Medicare covers this test once every 48 months, but not within 10 years of a screening colonoscopy. You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient department. Covered by Medicare Part B.

Barium Enema: Doctor can use this instead of a flexible sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount. Covered by Medicare Part B.

Mammogram Screening - Medicare covers a mammogram screening once every 12 months for all women with Medicare age 40 and older. You can also get one baseline mammogram between ages 35 and 39. You pay 20% of the Medicare-approved amounts with no Part B deductible. (2)** Covered by Medicare Part B.

Medicare covers new digital technologies for mammogram screenings. You pay 20% of the Medicare-approved amounts with no Part B deductible. (2)** Covered by Medicare Part B.

Other Cancer Screenings - Medicare also covers routine cancer screenings for cervical and vaginal cancers for women and prostate cancer for men.

Vaccinations - Medicare covers all people with Medicare for:

Flu Shot - Once a year in the fall or winter. The flu is a serious illness that can lead to pneumonia. It can be dangerous for people age 50 and older. You need a flu shot each year because flu viruses are always changing. The shot is updated each year for the most current flu viruses. Also, the flu shot only helps protect you from the flu for about one year. You pay nothing for pneumococcal pneumonia and flu shots if the doctor or health care provider accepts assignment. Covered by Medicare Part B.
Pneumococcal Pneumonia Shot (vaccine) - One shot may be all you ever need. Ask your doctor.
Hepatitis B Shot (vaccine) - If you are at medium to high risk for Hepatitis B. You pay 20% of the Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. (1)*(2)** For Hepatitis B Shot given in a hospital outpatient department, you pay a set copayment amount. Covered by Medicare Part B.

*(1) In 2008 you must pay an annual $135 deductible for Part B services and supplies before Medicare begins to pay its share.

**(2) Actual amounts you must pay may be higher if doctors, health care providers, or suppliers do not accept assignment.

Further Information

For more specific, free information about these benefits and other Medicare preventive services, download the Guide to Medicare's Preventive Services (Quick Reference Information). Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.